Yohnny 11 year old Shih-tzu with Cushing-like problems

Just keeping you in the loop with Yohnny.
Good news :)
He did his second Pre Cortisol Vetoryl Pill Tes today after 2 month on Vetoryl and this is his result:

Cortisol-Vetoryl 76,1 nmol/l 30 - 200 emås

Also his U-Protein/Crea quote is now 0,5 (Earlier it was up at 1.7 and then 0.9 after a moth of Vetoryl)

I am happy. They did find a small heart murmer (Level 1 of 6) so wanted to ask if it is ok to give supplements for this? Just to help his heart a a little. My understanding is to stay away from fats, but would it be ok to give CoQ10 oil?

Thanks in advance. /Amanda

Hi Amanda, and thanks for this excellent report! I’m so happy for you two! ;)

As far as the CoQ10 oil, I’m afraid I don’t know anything about it so I can’t make a recommendation one way or the other. I doubt that the fat from the oil would present any problem, but I just don‘t know whether the supplement itself would be a help in this situation. If the vet recommended it, though, I’d think it would be fine.

Continued best wishes to you both!
Marianne

Great update on Yhonny! Always nice to hear good news! The CoQ10 should be fine to use and can help with any heart issues, along with other conditions. Here is a link to an article written by Drs. Steve Marsden, Shawn Messonnier, and Cheryl Yuill.

https://vcahospitals.com/know-your-pet/coenzyme-q-10

My boy Yohnny is on Vetoryl 10 mg per day taken in the morning. He ways 7kg/15 lbs. He is 13 years old. He started Vetoryl April 29, 2020 and has improved and been doing good.

His most recent Pre Vetoryl Tests have been 148/138/149 (30-200) but this latest one was different: 51 (Sep 14, 2021)

U-Proteine/krea was high before Vetoryl (1,4 to 1,7) and then since Vetoryl between 0,5 and 0,9. But agian, the latest one was 1,2 (Sep 14, 2021) Should be < 0,5

Also from Sep 14 blood test:
ALAT-BM 1,7 ukat/l < 1,2
ALP -BM 12,8 ukat/l < 1,4
Kreatinin -BM 52 umol/l < 135

He has been doing great until Sunday when he seemed to have less energy than usual, also yesterday walking very slowly. And today he threw up his lunch. Poop is good.

He ate a small dinner at 4 pm and this has stayed in his stomach. But now when I was going to offer him a little more food (He eats small portions 4 times a day) he just tasted it and left the plate. This has NEVER happened. He usually has a ravenous appetite and finishes food in seconds. But he did want banana.

I called vet (animal hospital internal medicine) and her opinion was to see if it might be something temporary. If not I should wait and skip one dose of Vetoryl tomorrow morning. Of course if he gets worse I should go to the hospital.

His tummy seems a little swollen and more sensitive to touch than usual He did have the typical potbelly but this has got better - but now seems to be back a little.

I am of course worrying and would love some thoughts/comfort/advice from this group. I think my vet is competent but I also read about all the mistakes vets have made. He has some symptoms mentioned for low cortisol: vomiting (once), lethargy, reduced appetite, But not diarrhea, weakness, collapse.

Input welcome so I can either calm my nerves a little - or get ready to go to hospital.
Thanks ❤, Amanda

Lack of appetite, vomiting, lethargy... all pretty clear signs to stop Vetoryl until you can figure out whats going on. Pretty sure Vetoryl says to stop w/ these symptoms. Much better to deal with higher cortisol for a few days than an Addisons crisis. Might just be getting too high a dose. As time goes by, it seems we find that smaller doses of Vetoryl do the job. Others on the forum will be more equipped to dive into those numbers.

Good luck Amanda. Hope you get it figured out. You came to a good place.

Thanks Kevin.

Welcome back, Amanda. As you’ll see, I’ve merged your new question into your original thread so we can have Yohnny’s whole history here for us to refer to.

Many thanks to Kevin for his prompt reply to you, and I agree with him 100%. From the sound of things, I would guess that Yohnny’s cortisol is now dropping too low for his comfort. Even though he’d been doing quite well earlier and his Vetoryl dose had stayed the same, he may be responding differently now to that same dose. It is not unusual for doses to have to be changed over time, and this most recent monitoring test shows a significant drop in his cortisol level (down to about 1.8 ug/dL for our U.S. readers).

So I totally agree with Kevin, and I would not want to restart his Vetoryl again until he is once again eating and behaving normally. Even at that point, reducing his dose, at least temporarily, would likely be the safest thing to do. It’s possible that something else may be going on, but I do think that low cortisol is the most likely culprit until proven otherwise. Hopefully giving him a break from the Vetoryl will allow him to normalize quickly. But if not, as your vet suggests, a trip in to be examined will be important.

Please keep us updated as to how he’s doing tomorrow, OK?
Marianne

Hi Marianne! So nice to be greeted by you!

Thanks for confirming this. I have read about Addison crisis and got scared he was/is having one. But I guess that is not the case here?

He has slept pretty well, he ate some banana around 5:30 - when I got hungry ;) - but at 9 am breakfast he did not want his regular breakfast or banana (which he usually loves) instead he opted for a few treats.

We then took a short walk, he peed and pooped (normal) and now he is resting again. He did try and throw but not much in his stomach. He is very tired.

He did not get his Vetroryl this morning. What should I expect/look for today and tomorrow? Obviously if he gets worse - more lethargic, vomiting, shaking etc - I will go to ER. But anything else? How long does it take to normalize?

One more thing, looks like his potbelly is back slightly. Can this be the case when this happens?

Thank you, Amanda

Update 8 pm local time. Yohnny has been sleeping all day except for when I have fed him. He ate a little cooked white fish this afternoon and about half an hour ago he actually seemed a little more hungry and ate a slightly bigger portion fish and drank some broth. But he still seems very tired and weak. He barely wants/is able to walk. But he did wag his tail a little for the first time since he got sick. Carried him out for a pee. Is this still what to expect? He has now been 36 hours without Vetoryl. What if he is the same tomorrow? Feeling anxious.....

After this much time, I would let your vet know that Yohnny is still doing poorly. If his adrenal function has been oversuppressed by the Vetoryl, simply stopping the Vetoryl may not be enough help for him right now. He may need some supplemental prednisone pills, at least temporarily, to make up for the lack of cortisol coming from his own adrenal glands. He may also be suffering from a lack of aldosterone, which is another adrenal hormone. If his aldosterone level is too low, that can throw off his blood chemistries, most especially potassium and sodium. Again, sometimes a supplemental replacement is needed until the adrenal glands rebound to normal production.

So I would definitely contact your vet and let her know that he’s not doing well. She may want to see him personally, or she may prescribe a steroidal supplement that you can get for him yourself. Either way, I think she needs to know he is not doing well. I’m so sorry!

Marianne

Thank you so much Marianne. I will be calling my vet first thing in the morning (in 5 hours) Amanda

Update: Took Yohnny to vet yesterday morning. They admitted him. He could barley stand or walk. They gave him painkiller and intravenous drip. Did ultrasound and xray and bloodtests. Results came back with anemia, elevated kidney levels (could be dehydration), elevated liver values, and elevated "sedimention rate" (not sure this is correct translation). He is staying, he is stable, and they are going to do more tests today to see how they compare to yesterday. They did a needle test on his liver and will have the result of that today too. I am so worried adn want him home. Will give you numbers and more info when I have it. he has had an enlarged liver since he was diagnosed with Cushings. Now they see that part of the liver looks ”different” vet is hoping to find out what the ”difference” is due to.

I’m so sorry he’s feeling poorly! Absolutely you did the right thing by taking him in. I know how much you want him back home again, and hopefully this is a problem that’s only temporary. We’ll anxiously await additional news whenever you’re able to tell us more.

Sending healing hugs to Yohnny, and comforting hugs to you. We know how hard this must be for you, and we’ll stay right here by your side.

Marianne

Marianne! POSITIVE UPDATE. Yohnny is home :)! Vets are not totally sure what the issues were, but he has his energy and appetite back and is standing and walking again.He had a strong systemic inflammation. He may have eaten something. His arthritis coupled with systemic inflammation could be the reason he did not want to stand or walk. Vets do not think it had to do with his Cushings. But they will meet with his cushings vets next week so we will see if there is any connection. Once again thank you for your wonderful support Marianne. I hope you have a wonderful weeked.

That’s great news!!!! I’m so happy for you two!!!

I am curious whether they did check Yohnny’s cortisol level there at the hospital. Of course, something totally different may have been going on. But we have witnessed this same chain of events with other dogs who have been overdosed with Vetoryl: near total collapse and then a swift miraculous recovery once they receive IV fluids to restore their blood chemistries, as well as supplemental steroids if needed. So I’m still left wondering whether or not oversuppressed adrenal function may have played some part in this.

It’s very good that they’ll be consulting with his Cushing’s vet next week. In the meantime, I’m hoping they’ve told you to keep him off the Vetoryl until they do have the chance to consult. If Yohnny was my dog, I would want to let him bounce back from this ordeal and hear from the specialist before restarting the medication.

But for sure, this is very good news to take us into the weekend!
Marianne

Thank you Marianne. We are both enjoying very much being together at home today. Vet told me they check his "salts" due to his Cushings. Not sure what that means though. He has been off Vetoryl since Wednesday.

This is summary from vet:

Due to Yohnny not currently on vetoryl, no cortisol levels were taken to see check his medication dose.

A general blood sample was taken which showed mild anemia, elevated liver values, high blood platelets and a strong systemic inflammation.

The platelets and liver values correlate to Yohnny's cushings and there is nothing that worries me. The proteins that show liver function, as well as Yohhny's bile acids - which also show the function, were completely normal. So Yohhny's liver works well.

The anemia is difficult to say what it is caused by, Yohnny has had some low red blood cells before. Inflammations in the body can cause some low red blood cells. I think these should be followed up.

The red blood cells are not so low that they affect how Yohnny feels. He has fine mucous membranes and a normal pulse so the heart does not need to pump faster.

What stood out in the blood test was thus the strong systemic inflammation picture.

Ultrasound of the abdomen showed an altered area in the liver. The liver was also large, which it can become in Cushing's disease. A sample was taken from the changing part of the liver, the sample was unfortunately not diagnostic but to know for sure what the change in the liver is requires that you open the stomach and take a biopsy. I consider it unlikely that it is the change in the liver that is behind the deteriorating health as Yohnny got better so quickly on drip and pain relief. Had something malignant (cancer) in the liver caused his bad health, one does not expect such a treatment response.

Ultrasound examination of the heart showed that the heart is working fine, he has a leaking valve but there is nothing that currently affects him in any way and he therefore does NOT need to take any medicine for his heart disease. He therefore also has no increased risk of anesthesia.

In conclusion, it is difficult to say what made Yohhny so bad. How he was feeling probably correlated with the strong systemic inflammation. He responded nicely and quickly to drip and pain relief. It could be that he simply ate something inappropriate (food poisoning / gastritis), he also has severe osteoarthritis of the elbow joints and hip which, together with the general feeling of illness you get from such severe inflammation, may have contributed to his unwillingness to move . Of course, it is not possible to say for sure, but I am very happy to see how quickly he recovered - something that speaks against a disease of a more serious nature that you always have in the back of your head with older dogs (cancer)!

Give no more Vetoryl until I have consulted your other vets. We will talk next week!

I’m so relieved to hear that Yohnny remains at home and is still doing well. And thanks so much for your detailed summary of the vet’s report. The one piece that really surprises and disappoints me, though, is the fact that they did not check Yohnny’s cortisol level. Truly, I think that low cortisol remains a possible explanation for his collapse and I don’t understand why they wouldn’t have checked that. I’ve gone back to review what you had written about his recent pre-Vetoryl tests:

Quote:

---

His most recent Pre Vetoryl Tests have been 148/138/149 (30-200) but this latest one was different: 51 (Sep 14, 2021)

---

For our U.S. readers, those first three results all translate to between 5 - 5.4 ug/dL. The September reading had dropped clear to around 1.8 ug/dL. Something had happened to cause Yohnny to metabolize the medication differently even though his dose was unchanged, and his cortisol may have dropped even further at the time of his collapse. It would have been really helpful to know what his level was at the time he was hospitalized. And I’d definitely want to know where his level is at before considering starting back. Whether or not there’s something else going on that is responsible for the change in his response to Vetoryl, we do not know. But as I said earlier, we’ve seen cases where dogs simply end up processing the medication differently over time, requiring dosage changes as a result. If appropriate changes are not made, dogs can end up overdosing with results that look very similar to what happened to Yohnny.

So, for sure I’ll be very interested to hear what your Cushing’s specialist has to say about all this in the coming week. In the meantime, I surely hope he continues to do well!

Marianne

Hi Marianne and thank you for being so involved and adament about Yohnny’s health. Vet that had been taking care of Yohnnys cuahings called today. We are going in for an ACTH test tomorrow morning. So in you opinion they should have done this earlier? Is there anything else I should ask/keep in mind when I see vet tomorrow? Thank you ad always.

I’m so glad to hear about the ACTH test. The current status of Yohnny’s cortisol production will be the most important factor in making a decision about restarting his Vetoryl, and if so, at what dose. When you took Yohnny in to the hospital at the time of his collapse, they may not have been able to do a full ACTH due to his condition and also the IV meds he was receiving. But in my opinion, they definitely should have at least checked his baseline cortisol level as part of his initial blood draw.

But I think an ACTH now will be very important. Also, I would think your vet would want to draw enough blood to check Yohnny’s basic blood chemistries as well. The balance of sodium and potassium is especially important to monitor, both when a dog is actively taking Vetoryl or also when an overdose has been suspected.

That’s the main thing I can think of in advance of your visit tomorrow. Good luck!

Marianne

Thank you Marianne. This is very helpful. Still waiting for results of ACTH test. In the mean time vet called and his red bloodcell count has gone down. 32 lats Thursday, now 23. Vet asked for a stool sample so that is my mission right now. The knot in my stomach is back. :(

That knot...it's something we all get...watching for signs, waiting for vet visits, waiting for test results. We love our babies so much and only want everything to be okay with them. I hope that only positive results come back for Yohnny.

Oh me, too! We’ll be waiting anxiously to hear more as soon as you find anything out.

Marianne

Quote:

---

Originally Posted by Joan2517

That knot...it's something we all get...watching for signs, waiting for vet visits, waiting for test results. We love our babies so much and only want everything to be okay with them. I hope that only positive results come back for Yohnny.

---

Thank you for reaching out. Feels good to have contact with people who understand.

Everyone on this site understands...we've all been there. There is nothing that you haven't gone through that members here haven't.

Thank you Joan.

Update: Evening on Nov 4 Yohnny fainted. Went to vet next day (Nov 5) we where worried a hard decision had to be made. Took a lot of blood tests, stool sample, xray and ultrasound (2nd one in 3 days). He still has anemia but numbers are better (but still not within range). ACTH stim test showed adrenal glands working (Cortisol 0 min 130/<120 Cortisol 60 min 342/<350). His liver still has something going on but they could not find any blood leakage on ultrasound, but he did have blood in his poop. They are now treating for gastric catarrh and stomach ulcer (Losec+Andapsin). In general he seems ok we is alert when things are going on in but does have much lower energy and sleeps more. He eats well, goes out to peep and poop, although poops is loose (maybe due to medicine?) Our plan is to try this medicine and see if it will help. Today Nov 8 he is a little perkier. Vet is contacting me this week. Cannot figure out how to attach Lab results and vet notes.

Thank you so much for the update! And thanks so much for the ACTH report — yes, it looks like I can finally stop worrying about low cortisol! I’m very relieved about that, but sorry to hear about the internal bleeding. Unfortunately you can’t add any attachments to your replies other than in photo form. But you’ve done an excellent job all along about explaining to us what the vets have told you. It sounds like a stomach ulcer might definitely be the source of the bleeding, and hopefully the new medication will really help. We’ll continue to watch for more news this week.

Sending healing pats to your sweet boy!
Marianne

Dear Marianne and group,

Quick update. After 3 weeks of Losec and Andapsin for his stomach Yohnny is doing well! His energy and spunk is back. And once we stopped with the Losec his stool was normal too. We will be going in for a blood test and check-up on anemia etc beginning of dec. Thank you for your support. I think I figured out how to attach a photo of him...after he was sniffing a pile of leaves... ;) https://imgur.com/a/qOnakBZ

Oh my, this is *great* news — thanks so much for the report!!! And thank goodness for that new medication! I’ll definitely be watching for your photo of your sweet boy :-)))))))

Best wishes, as always!
Marianne

Hi! Yohnny and Amanda here. It's been a while. After the stomach problems in November last year. Yohnny has had to have an eye removed and several teeth removed in a big surgery (not cushing's related) and he is struggling with anemia/stomach issues - this has taken a toll on him physically, but he is not in pain and still has that twinkle in his eye and is a happy dog.

I am looking for some practicle and emotional support. He has had loose stool since Thursday and I am worried. He seems ok in general but needs to go out in middle of the night etc. The question is how worried should I be? His health issues have taken a financial toll on me and I don't want to take him to the vet unless I really have to - also for his sake since he has been so much.

I know it is hard for you all to give direct advice without knowing anything and seeing the situation yourself, but how do you think in these hard situations when it does not seem to be an emergency...but I am worried that if I wait it might become one....

Thanks for any input.

If he's still taking Vetoryl, I would stop for a few days and see if that makes a difference.

Ok. Thank you. Seeing vet today.

Hi, Amanda,
Sorry for the delay in responding to you.

How was his last ACTH test? Any signs of loss of appetite or nausea or lethargy? If the ACTH was good and you aren't seeing any other signs of low cortisol I would tend to think this is unrelated to Cushing's and may be due to something he ate or stress or a return of the prior tummy problems. Any sign of blood in the stool?

Thank you for respons. He is doing better now and his tummy has calmed down. No loss of appetite or nausea or lethargy. Have met with his vet. She does not think it is Cushings related either. Latest pre-vetoryl test was a little above the "correct" number but not enough to worry vet (she is IMS) we are taking one again soon. He does have a sensitive stomach so I am working on that. Thanks again.

I apologize for being so late to get back to your thread, but I’m very relieved to know that Yohnny is doing better again now. Sometimes these GI upsets can be so hard to figure out. My elderly non-Cushing’s Lab periodically has episodes of inappetance and loose stools, and for the life of me, I’ve yet to figure out the trigger. But fortunately for us, she ultimately gets over them and it sounds like the same thing has happened for Yohnny, too. Anyway, I’m very glad to know he’s feeling better!

Marianne